BadgerCare+ Bulletin is published by HealthWatch Wisconsin, a project of ABC for Health, Inc. This periodic newsletter tells families, friends and advocates more about how to get, use, and keep health care benefits.Visit us online:www.healthwatchwisconsin.org.
BadgerCare Plus is Still Available for Children and Families!
In this issue of the BadgerCare+ Bulletin, we are myth-busting! You might have heard rumors that the BadgerCare Plus program has ended, but this is not correct. BadgerCare Plus still exists, and benefits are still available!
Listing of some of the programs that fall under the heading "BadgerCare Plus"
BadgerCare Plus is made up of many different programs. As changes are made to one of these programs it is easy to be confused if the services you receive are still available. Recently, changes have been made to a few programs, like the BadgerCare Plus Basic Plan and Core Plan. BadgerCare Plus for children, families, and pregnant women is still available!
This newsletter will start with a refresher of who is able to get BadgerCare Plus for children, families and pregnant women, and then will explain the recent changes to the Core Plan and Basic Plan. We'll then give more information on the "Family Planning Only Services" program. In a future edition of this newsletter, we will look at the two programs currently available for those living in Wisconsin without current immigration paperwork: the "Prenatal Program" and "Emergency Services" program.
First, let's take a look at the BadgerCare Plus for children, families, and pregnant women, its benefits, and how to apply for them!
BadgerCare Plus for Children, Families and Pregnant Women
BadgerCare Plus is a health coverage program in Wisconsin. It is an important public-private health care partnership between the federal government, the state of Wisconsin, health plans,
medical providers and the people of our state. Over 775,000 people in Wisconsin rely on the program to provide vital health care services.
BadgerCare Plus for children, families and pregnant women is the primary BadgerCare Plus program--the one most people think of when they hear "BadgerCare." This program offers free or low-cost health care coverage to certain Wisconsin families and individuals.
Who Can Get BadgerCare Plus?
You will first be asked if you live in Wisconsin, are a citizen (or can prove your immigration status), and whether you fall under a certain income limit.
You then will have to answer additional questions about your family--do you have children under the age of 19 in the home? Are you pregnant? Are you a relative taking care of a child?
If you answered "yes" to any of these questions, chances are you are on your way to getting BadgerCare Plus.
Remember, the state will need to know your income to determine if you fit the right category of health care coverage. Using your income and family size, the state will calculate where you fall on the "Federal Poverty Level" (FPL). Click here to learn more about FPL or visit www.safetyweb.org/fpl.html.
How To Apply
To see if you can get BadgerCare Plus, you will need to fill out an application form. It's just like filling out a survey that asks about you and your family:
How much money you make if you are working,
The names of the people living in your house and how you are related to them,
Birthdays of everyone in your house,
Social security numbers (or registration numbers for immigrant families)
Whether you have private health insurance right now
BadgerCare Plus offers two different health plans, each which offers a different level of benefits: the Standard Plan and the Benchmark Plan.
Standard Plan
The Standard Plan provides the most complete package of benefits and services, also known as "full Medicaid benefits." This plan is available for certain groups of people with incomes at or below 200% of the FPL.
Benchmark Plan
The Benchmark Plan covers limited services for certain groups of people with incomes higher than 200% of the FPL. Unlike the Standard Plan, the Benchmark Plan requires members to pay premiums. It also requires higher co-payments than the Standard Plan.
Covered Services
BadgerCare Plus covers a variety of services, including doctor visits, hospital and emergency care, check-ups, immunizations, eyeglasses, hearing aids, prescriptions, mental health services, prenatal care, and family planning.
BadgerCare Plus Core Plan-This Program Has a Waiting List
BadgerCare Plus Core Plan
Sometimes called just "Core Plan" the BadgerCare Plus Core Plan is intended for adults without children in their home. This program looks at your age, income, and a few additional factors such as if you have had insurance in the past year, to see if this is the best health care coverage program for you. There is a $60 fee to sign up for the Core Plan, and a "renewal" fee every year of $60.
This program started in 2009, but the program is not taking new members. Instead, if you complete an application for the Core Plan, you are placed on the Core Plan's waiting list. Note: you do not have to pay $60 to get on the waiting list. The fee is owed if your name is taken off the waiting list and you are in the program.
Core Plan Waitlist
As of October 9, 2009, all the open spots in the program were filled. Now, anyone who applies for the Core Plan gets put on a waiting list.
Currently, the state has not yet moved anyone off of the waiting list and onto the program. The waiting list is nearly 100,000 people long. That does not mean you shouldn't apply! It is important to show the great need for the Core Plan and to let legislators and department officials know that people are struggling, waiting for a program to meets their needs.
Individuals currently using the Core Plan for health care coverage have services such as doctor visits, generic pharmaceuticals and hospital visits covered. Regular dental services and nursing home care are not covered. For more information on the Core Plan, including a listing of covered services, click here.
How To Apply for the Core Plan Waiting List:
There are only two ways to sign up for the Core Plan waiting list:
Sign up for the waiting list over the phone: Call 1-800-291-2002
BadgerCare Plus Basic Plan - This Program Has Frozen Enrollment
The BadgerCare Plus Basic Plan, also called just "Basic Plan" was created as a very limited benefit health care coverage plan--for only those people who were on the BadgerCare Plus Core Plan waiting list. The program rules allowed someone on the waiting list to "buy into" the Basic Plan, or pay a monthly premium to get the coverage. In the middle of March, the state of Wisconsin changed the way the Basic Plan works.
If you heard a rumor that "BadgerCare Plus ended" or "the Basic Plan ended" that is incorrect. The Basic Plan still exists for people that are already signed up for the program. The program will not allow any new people to sign upfor the Basic Plan. The state made a second change: the Basic Plan's premiums went from $130 a month to $200 a month. The original Basic Plan also had a unique feature for individuals with cancer or other chronic diseases where they could "skip" the Core Plan waiting list and get right to the Core Plan. The new rules no longer allow this.
Remember that people already in the program can stay in the program as long as they continue to meet the plan's rules and requirements. mainly that their income doesn't change, they do not have access to other insurance and they continue to pay premiums on time.
Covered Services
The Basic Plan has limited health care coverage that includes:
Up to 10 doctor visits per year,
Some hospital visits,
The first inpatient hospital stay and five outpatient hospital visits (the patient has to pay for the next $7,500 worth of hospital visits. After this, hospital stays are covered again.),
Up to 5 emergency room visits per year,
Some generic medicines, and
Membership in the BadgerRx Gold drug discount program.
Basic Plan members must pay co-payments for doctor visits and other services.
Special Note on Paying Basic Plan Premiums
If you are on the Basic Plan, you know that each month you get a "premium payment slip" in the mail. You must pay the full $200 of your monthly premium by the 5th of each month in order for your benefits to exist in the next month. For example, if you pay your $200 by June 5th, you essentially paid for your July month of coverage. If you miss paying this premium, your coverage stops and you cannot get it back. As a special note: be aware that sometimes the payment slips reminding you to pay your $200 premium do not come on time. It is important to continue to pay by the 5th of each month, even if you haven't seen the slip.
BadgerCare Plus Family Planning Only Services
This BadgerCare Plus program called "BadgerCare Plus Family Planning Only Services" or sometimes called "Family Planning" provides certain services such as contraceptives, pharmacy visits, tests for diseases and
routine sexual health visits to a doctor. The purpose of the program is to prevent unplanned pregnancies and sexually transmitted diseases (STDs). This program used to be for both men and women in Wisconsin that fit certain rules, such as being 15 or older, being under a certain income limit (300% FPL) and not already getting other BadgerCare Plus benefits.
There are two more BadgerCare Plus Programs: the BadgerCare Plus Prenatal Plan and BadgerCare Plus Emergency Services. HealthWatch Wisconsin will be highlighting these programs in a future newsletter.
HealthWatch Wisconsin's Immigrant Health Options Webcast, airing live on July 21, will take a closer look at both of these programs! If you're a member of HealthWatch Wisconsin, click here to register for the webcast for FREE! If you aren't a HealthWatch member, keep reading below!
Support HealthWatch Wisconsin!
If you like HealthWatch Wisconsin newsletters but want more, you should consider joining HealthWatch Wisconsin! Membership is just $35 per year, and you get access to a great number of benefits, including publications, discounted rates for trainings and events, and online access to our HealthWatch Wisconsin Training Site.
Click here for more information on registering online. To register over the phone, or if you have any questions, please call 1-800-585-4222 ext. 204.
This year, Wisconsin's Medicaid and other public health care programs have come under attack. It is important that the people who need and use these programs speak out and share their stories, so that the rest of Wisconsin - especially the legislators - know what's at stake when they make cuts and changes.
In early March 2011, HealthWatch Wisconsin hosted public hearings to focus attention on the impact of BadgerCare and Medicaid cuts on the 1.2 million Wisconsin residents who benefit from these programs. The event drew hundreds of people to listen, learn, and for some, to share their stories and the stories of loved ones.
If you want to share your own story, please contact ABC for Health. Call 1-800-585-4222 ext. 208 or email info@safetyweb.org.
Words to Know
Federal Poverty Level (FPL): A minimum income level below which a person is officially considered to be living in poverty. A simple version of the federal povertythresholds used to decide financial eligibility for certain federal and state programs. It is issued each year by the U.S. Department of Health and Human Services. The FPL is set using weighted averages of final federal poverty thresholds. It is made available in the Federal Register.
